2021 PURE Insurance Championship Impacting The First Tee - North ...
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2021 PURE Insurance Championship Impacting The First Tee
September 21-26, 2021
Pebble Beach Golf Links and Poppy Hills Golf Course
IMPORTANT: Completed applications must be returned to Coach Ron on or before Monday, April 5th
Overview:
The PURE Insurance Championship Impacting The First Tee showcases the best junior golfers across the First Tee chapter network
and celebrates their dedication to the game of golf and local chapter. This tournament is an official PGA TOUR Champions event, at
Pebble Beach Golf Links on the Monterey Peninsula, that pairs one junior with a PGA TOUR Champions player and two amateurs.
To be selected, juniors are measured in both golf proficiency and life skills knowledge. The tournament is televised nationally on Golf
Channel.
Participant Selection:
Up to 78 participants are eligible to play in the event. The participants from First Tee will be selected based on their online application
scoring. If selected, participants must be available to travel to California on September 21 – 26, 2021.
Eligibility Requirements:
For participants of First Tee to be eligible for the PURE Insurance Championship Impacting The First Tee, they must meet ALL of the
following requirements:
• Participants must be between 14 and 18 years old (applicants must reach their 14th birthday by the first day of the event date
and not have reached their 19th birthday by the conclusion of the event).
• Classified as a high school freshman, sophomore, junior, or senior as of fall semester 2020. High school seniors at the time of
application deadline are not eligible to apply, as they will be full-time college students or 19 years old at the date of the event.
o **Due to First Tee participants being unable to participate in the 2020 PURE Insurance Championship, participants
who applied for the 2020 opportunity and will graduate high school in the Spring of 2021 will be eligible to apply
for the 2021 PURE Insurance Championship. This provision will be allowed only for 2021 and is not a permanent
change in the eligibility requirements.**
• Entered in Salesforce and has been an active participant for a minimum of two years
• Must be at Birdie level or higher at the time of application deadline
• Chapters must have signed their contract at least 3 years before application deadline in order to submit applicants
• Competitive Golf Ability – must have a USGA handicap of 6 or better for males and 8 or better for females
• Players must be physically and mentally able to play up to 5 rounds in one week, while walking, carrying their own bag, and
keeping pace of play according to the PGA TOUR Rules and Competitions guidelines
• Participants who previously attended the event are not eligible
• Each chapter may nominate up to five participants for the PURE Insurance Championship
Application Process:
Applications will be submitted online at https://firsttee.smapply.org; please follow the instructions in the “Quick Start Guide” on how
to complete this process. Please contact your chapter representative if you have difficulty with the application process. The online
application will consist of the following:
• Application Code
• Participant General Information and Family/Medical Information Form
• Golf Resume, School & Community Activities Chart, & Four (4) Short Answer Essays
• Chapter Interview Form (to be completed by a chapter representative and uploaded by the participant)
12021 PURE Insurance Championship Impacting The First Tee
September 21-26, 2021
Pebble Beach Golf Links and Poppy Hills Golf Course
• Chapter Participation Survey (to be completed by a chapter representative and uploaded by the participant)
• Participant Bio Form
• Headshot
• Social Media, Code of Conduct and Model Release Form
• Liability Form
Below is a copy of the application you will need to complete online; please refer to the application below to make sure that you have
all of the information you need to complete your application online. Online application must be submitted by the First Tee participant.
First Tee will not accept paper applications, emails, or correspondence from families of participants. The deadline to apply online is
April 12, 2021.
COVID-19 Protocols:
• Participant chaperone must be a parent or legal guardian
• Masks and social distancing will be required
• Temperature & symptom checks will occur every morning
• Further protocols to be shared with chapters, participants and parents prior to application deadlines.
Selection Process:
Following the closing date of April 12, 2021, a judging committee made up of First Tee headquarters staff members, chapter staff and
tournament officials will review and assign point values to the categories. Once the selected participants have been identified, the
announcement will be made on Golf Channel’s Morning Drive in July. Specific information regarding the announcement date will be
provided at a later time.
Lodging and Transportation:
First Tee has secured a discounted room rate at the Monterey Marriott for First Tee participants and their chaperone to utilize. All
guest room arrangements will need to be made by contacting the hotel directly. A reservation link will be sent to all selected
participants for them to make their own arrangements.
First Tee will provide each participant who will be flying a flat stipend of $2100 to assist with the cost of airfare, lodging, and rental
car arrangements for the participant and chaperone. Participants who live within 150 miles of Pebble Beach will be required to drive,
and receive a flat stipend of $1750 to assist with the cost of travel, lodging, and rental car.
Questions: For questions regarding the PURE Insurance Championship Impacting The First Tee please contact Brandon Luna at
brandonluna@firsttee.org or 904-940-4311.
22021 PURE Insurance Championship Impacting The First Tee
September 21-26, 2021
Pebble Beach Golf Links and Poppy Hills Golf Course
GENERAL INFORMATION FORM
Participant Name (First and Last):
Chapter:
Participant E-Mail: Participant Cell #:
Current Home Address: Home #:
City: State: ZIP Code:
Parent/Guardian #1 Full Name: Parent/Guardian #2 Full Name:
Parent/Guardian #1 Full E-Mail: Parent/Guardian #2 E-Mail:
Parent/Guardian #1 Cell #: Parent/Guardian #2 Cell #:
Date of Birth (MM/DD/YYYY): Age as of Date of Event:
School Grade Level: 2020-2021 School Year: High School or College Grade Point
High School Average (based on a 4.0 scale):
☐ Freshman ☐ Sophomore ☐ Junior ☐ Senior
Gender: ☐ Male ☐ Female
Are you a current member, or a past member, of LPGA-USGA Girls Golf?
☐Yes ☐No
Ethnic Background: Shirt Size:
☐ Asian ☐ Extra Small
☐ Black or African American ☐ Small
☐ Hispanic or Latino/a ☐ Medium
☐ Native American or Native Alaskan ☐ Large
☐ Pacific Islander ☐ Extra Large
☐ White or Caucasian ☐ XXL
☐ Multi-Racial
Years playing golf: USGA GHIN # (if none, “N/A”): USGA Handicap:
Chapter Contact Full Name: Chapter Contact E-Mail:
32021 PURE Insurance Championship Impacting The First Tee
September 21-26, 2021
Pebble Beach Golf Links and Poppy Hills Golf Course
FAMILY INFORMATION FORM
Parent/Guardian #1 Full Name: Parent/Guardian #2 Full Name:
Parent/Guardian Permanent, Legal Address:
City: State: ZIP Code:
Parent/Guardian #1 Employer:
Parent/Guardian #1 Occupation: Phone #:
Parent/Guardian #2 Employer:
Parent/Guardian #2 Occupation: Phone #:
MEDICAL INFORMATION FORM
Is participant covered by insurance? ☐ Yes ☐ No Military or Medicaid? ☐ Military ☐ Medicaid
Insurance Company Name: Policy Number:
Type of Coverage (Check all that apply): ☐ Health ☐ Accident ☐ Major Medical
Does the participant have any physical condition or handicap that
requires special medical treatment, diet or other consideration? ☐ Yes If yes, please explain:
☐ No
Does the participant have any allergies (food,
drugs, stings, pollens, etc.)? ☐ Yes ☐ No
If yes, please explain:
Does the participant take any medication? ☐ Yes ☐ No If yes, please list:
Please list any previous illnesses or surgery: Age as of Date of Event:
I authorize First Tee and its affiliates to provide medical treatment and other necessary medical services for my child during the
entire period that he/she is a participant at a national participant opportunity. I affirm that all of the above information is correct to
the best of my knowledge.
Parent/Guardian Signature: Date:
Participant Signature: Date:
42021 PURE Insurance Championship Impacting The First Tee
September 21-26, 2021
Pebble Beach Golf Links and Poppy Hills Golf Course
GOLF RESUME
You must include your score, finish, the winning score, the tournament yardage and an event description. In addition, you will also
need to classify the event as local, regional or national. The template below reflects the online form.
Round by Event Description
Finish
Round & Course
Tournament Name Date Field Size
Total Yardage (i.e Regional, National, High
(Place)
Scores School, State)
EXAMPLE: Texas Jr.
March
Golf Tour – GC of 3rd 6108 yards
27–28, 76/74=150 37 State
Dallas Jr. Par 70
2020
Championship
52021 PURE Insurance Championship Impacting The First Tee
September 21-26, 2021
Pebble Beach Golf Links and Poppy Hills Golf Course
SCHOOL & COMMUNITY ACTIVITIES CHART
Please complete the chart below; more space will be available when completing this section online.
A. Extracurricular & School Dates (From – To) Responsibilities Accomplishments
Activities
Jan 2017 - Present Organized play dates Club President
Example: Golf Club
B. Community & Volunteer Dates (From – To) Responsibilities Accomplishments
Service
Dates (From – To) Responsibilities Accomplishments
C. Awards & Recognition
Accomplishments
D. Work for Pay Dates (From – To) Responsibilities
62021 PURE Insurance Championship Impacting The First Tee
September 21-26, 2021
Pebble Beach Golf Links and Poppy Hills Golf Course
SUPPLEMENTAL QUESTIONS:
Have you had a sibling or relative play in this tournament before? If so, what year and who did they play with? (50 word count)
Do you have any connections to PGA TOUR Champions players? If so, who and what is the connection (50 words)
SHORT ANSWER ESSAYS
Answer all four (4) of the following questions. Please use the space provided below (more space will be available when completing
this section online). Your response must be 300 words or less per question.
1. Who has been your First Tee mentor and how have they influenced your personal growth? (This could be a coach, staff
member, fellow participant, or alum)
2. What has been the hardest obstacle you have had to overcome in your life? How did you handle it? And, if you had to do it
again/over, how would you handle it differently?
3. What would being selected for the PURE Insurance Championship mean to you? (Think about what you have done to prepare
for the opportunity and what do you want to walk away with at the end of the experience).
4. If you had the chance to “tell your story” to a television audience, regarding the impact First Tee has had on your life, what
would you say?
72021 PURE Insurance Championship Impacting The First Tee
September 21-26, 2021
Pebble Beach Golf Links and Poppy Hills Golf Course
CHAPTER INTERVIEW FORM
Participant Name (First and Last): Chapter:
Judging Panel (list names and affiliations of those conducting the interview):
A requirement for the application process for the PURE Insurance Championship Impacting The First Tee is an in-person interview
conducted at the chapter. The following guidelines should be adhered to and the form below MUST be filled out and returned to
the participant, so they can upload it to their online application.
If selected, participants will be in the company of many prominent individuals – PGA TOUR Champions players, amateur players,
media, business men and women, etc. Participants are representing First Tee in front of an international audience. Therefore, it is
important to be prepared and comfortable with interviewing.
Interview Guidelines:
• Each participant must complete one 20 – 30 minute interview
• Each interview should be conducted with a panel of 3 to 5 judges
• We strongly suggest the judges are individuals that can be objective regarding the participant. They can be acquaintances.
o Suggested judges include board members, volunteers, donors, chapter staff members
o Chapter staff members alone should not fill the judging panel
• Each interview should include at least 5 questions (see suggested questions)
The two items should be kept in mind in terms of the context of the interview. They should be addressed in the Interview
Notes/Comments section of the Chapter Interview Form:
1. Based on the questions asked, how has this participant been impacted by the First Tee program? How well are they able
to communicate the impact?
2. Aside from the questions asked, how would this participant represent the First Tee Network at the tournament? Are they
articulate? Would they be comfortable interacting with the media, sponsors, PGA TOUR Champions players, amateur
players and external stakeholders? Can they convey the First Tee message?
PLEASE TYPE AND ATTACH INTERVIEW NOTES AND COMMENTS ALONG WITH THIS PAGE
Chapter Representative Name (First and Last): Position:
Signature: Date:
82021 PURE Insurance Championship Impacting The First Tee
September 21-26, 2021
Pebble Beach Golf Links and Poppy Hills Golf Course
Chapter Participation Survey
PLEASE COMPLETE AND SIGN: The following form is to be completed by a chapter coach, program or executive director for
each participant applying for a First Tee national opportunity. It is the participant’s responsibility to make sure this is filled out and
signed, and then uploaded to their online application. The same form can be used for multiple opportunities in the same year.
This form is a vital part of the criteria evaluated for national participant opportunities. Please complete it thoughtfully. You can type
directly onto this form,or attach a separate typed page with numbered answers.
Participant Name and Chapter:
1. How many years has this participant been involved with your chapter?
2. Please provide examples of how your participant has been engaged (with others, as a representative, or as a leader) at
your chapter within the past three years.
3. Please explain why you feel this participant should be selected for a national opportunity.
4. (Optional) Is there any additional information that you would like to add about this participant that has not been
covered by the questions above?
By signing below, I acknowledge that I am fully aware of and understand that if the participant recommended above does not
follow the Code of Conduct at the corresponding participant opportunity and is sent home early, the Chapter will be responsible for
any additional airfare fees inquired.
Name of chapter representative:
Signature:
Position at Chapter: E-mail address:
Date: Phone Number:
92021 PURE Insurance Championship Impacting The First Tee
September 21-26, 2021
Pebble Beach Golf Links and Poppy Hills Golf Course
PARTICIPANT BIO FORM
Once again, we have included the Participant Bio Form as part of the initial application. The purpose of this form is to gather
information and identify story ideas. Please be thoughtful and complete with your answers as these responses will be shared with
the media. Note that it will serve for background information purposes only and will NOT be scored by the judging committee.
BELOW, PLEASE LISE THE NAME YOU WOULD LIKE TO APPEAR ON ALL SUBJECT MATTER (I.E. BILLY
INSTEAD OF WILLIAM)
2. Chapter:
1. First & Last Name:
4. Age:
3. City, State:
6. Grade Level: (2020-2021 School Year and 2021-2022):
5. School Name:
7. Please list your future aspirations and the goals you’ve set to attain them (150 word count)
8. What accomplishments are you most proud of on and off outside the golf course?: (150 words)
9. How has First Tee helped equip you to take on new experiences and challenges? (150 words)
10. When I’m not playing golf, I also enjoy (for example: extra-curricular activities, community service, other sports,
hobbies, etc.): (100 words)
11. Tell us a fun fact about yourself? (50 word limit)
12. Twitter Handle:
Instagram:
13. Answers from your short essays and bio form may be provided to the media for promotional use. If there is anything
listed in your application that you do not want to be shared publicly, please indicate which questions below. (This will
not affect your score)
102021 PURE Insurance Championship Impacting The First Tee
September 21-26, 2021
Pebble Beach Golf Links and Poppy Hills Golf Course
Participant Headshot
Please upload your photo. Here are some important tips to follow when submitting a quality headshot:
• Look for bright lighting and a “nice” background – i.e. golf setting or outdoors
• Photo should not include other people, signs in the background, or logos on your clothing other than those of The First Tee
(optional)
• No hats
• No selfies
• Remember to smile
112021 PURE Insurance Championship Impacting The First Tee
September 21-26, 2021
Pebble Beach Golf Links and Poppy Hills Golf Course
First Tee Code of Conduct
First Tee takes great pride in the quality of its participants, scholars, host facilities, and community involvement at each and every
event or special opportunity. In order to make these events enjoyable for everyone, First Tee requires all participants to adhere to a set
of guidelines known as the Code of Conduct*. Its purpose is to help First Tee participants grow and mature by understanding and
accepting the consequences of their actions. Your signature at the bottom of this page indicates that you understand that the Code of
Conduct is to be followed throughout your stay at this event.
VIOLATIONS OF THE CODE OF CONDUCT
• Unsportsmanlike conduct, including abusive language, disrespect to staff, host, or volunteers
• Use or association with drugs or alcohol, smoking or chewing tobacco products
• Vandalism of any sort at host dormitory or hotel
• Conduct not becoming of a First Tee participant, such as acting in anger or creating other distractions
• Physical abuse, threat of physical abuse or verbal abuse to other participants, staff or guests
• Not adhering to the lights out policy
• Not adhering to the dress code
REQUIRED DRESS AT THE EVENT (Unless otherwise instructed)
• Hats/visors are acceptable during golf activities and must be worn with the brim forward. Males must remove hat/visor
while indoors.
• Collared shirts or mock turtlenecks must be worn and tucked in at all times
• Women’s fashion shirts without a collar are acceptable but must have sleeves
• Women’s shorts and skirts must be no more than 5” above the knee or the inseam of the shorts must measure at least 5”
Suggested attire for activities will be sent to participants prior to each event. Proper attire is required at all times including meetings
and free time. Questionable attire will be reviewed by on-site staff. Should a host facility have a stricter dress code, its policy will
take precedence.
CODE OF CONDUCT VIOLATION PENALTIES
Participants in violation of this Code will be prohibited from participating in the remainder of the event and may be sent home at their
own expense.
________________________________ _____________________________ _______________
Participant Signature Participant Printed Name Date
122021 PURE Insurance Championship Impacting The First Tee
September 21-26, 2021
Pebble Beach Golf Links and Poppy Hills Golf Course
Social Media Code of Conduct
The First Tee Social Media Code of Conduct requires participants to demonstrate the First Tee values in their everyday lives and, in
particular, to show respect for oneself, others and your surroundings. This is expected not only in face-to-face situations but also in
written correspondence and electronic social media interactions. We consider social media to include all personal Web sites and all
forms of online community activities such as online blogs, social networks, message boards, conversation pages, chat rooms, emails
and cell phone texting.
The First Tee Social Media Code of Conduct states that while using any social media platform to communicate with other Chapter
participants or with anyone about First Tee, you must abide by the First Tee Code of Conduct and the First Tee Values. If you are
unaware of what the Code of Conduct states, you can review with your chapter, or contact First Tee HQ. Also, the First Tee’s
copyrighted words, logos and trademarks may not be used in any manner on social media pages without headquarters approval. For
example, you cannot create a social media group that appears to be sponsored by First Tee.
It is very important to respect and follow the rules set forth when using any social media platform. If you fail to do so, there will be
consequences which may include cancellation of benefits and being prohibited from participating in future participant events hosted
by First Tee HQ. Headquarters will also involve parents and Chapter leaders in these discussions as needed. Thank you for your
attention to these guidelines.
Examples of Social Media (but not limited to): Facebook, Instagram, SnapChat, MeWe, Parlor, MVine, MySpace, Twitter,
IM/Chatting, Blogs, YouTube, Flickr, Email, Texting
________________________________ _____________________________ _______________
Participant Signature Participant Printed Name Date
132021 PURE Insurance Championship Impacting The First Tee
September 21-26, 2021
Pebble Beach Golf Links and Poppy Hills Golf Course
The First Tee Model Release
(For use with minors)
For good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, I hereby assign, authorize, give and
grant to PGA TOUR First Tee Foundation, Inc., a Florida not for profit corporation, together with its affiliates, successors, assigns,
sponsors, licensees and/or sublicensees (collectively, “TFT”), the unrestricted right and permission to copyright, exploit, use, re-use,
publish, republish, and/or sublicense all and any photographic portraits and/or pictures, and all and any audio and/or video images or
clips (each, an “Image,” and collectively, the “Images”), in whole or in part, of the below named minor (the “Model”) in which the
Model may be included, in whole or in part, whether composite or distorted in character or form, in color or black and white, made
through any media now or hereafter known for illustration, art, promotion, advertising, trade, or any other purpose whatsoever at any
time, by, or on behalf of TFT, including without limitation the use of any printed matter in conjunction with such Image(s). I
acknowledge and agree that TFT may, without prior consent or approval, assign this Model Release (this “Release”), together with its
rights hereunder, to any party acquiring all or substantially all of its assets.
I warrant that I am the parent or legal guardian of the Model named below and I have the authority to execute this Release on his or her
behalf.
I hereby agree that the terms and conditions of this Release shall also fully apply to me as a model in the event that I appear, in whole
or in part, in any of the Images or media related thereto.
I hereby waive and relinquish all and any right to examine, inspect and/or approve the Images, advertising copy and/or printed and/or
digital matter that may be used in conjunction with or contain such Images, or to the eventual use that such Images may be applied.
I hereby release, discharge and agree to hold harmless TFT and its agents, consultants, employees, independent contractors and other
representatives from and against all any claims, damages, expenses (including without limitation reasonable attorneys’ fees) and liability
(collectively, “Claims”) arising out of or relating to the Image(s), including, without limitation, any blurring, distortion, alteration, optical
illusion, or use of such Image(s) in composite form, whether intentional or otherwise, that may occur or be produced in the taking of
said Image(s) or in any subsequent processing thereof, as well as any publication thereof, including, without limitation, Claims for libel
or invasion of privacy.
I have read the above authorization, release and agreement, and I fully understand the contents thereof. This Release shall be binding
upon me, the Model and our respective assigns, heirs and legal representatives.
MODEL: PARENT OR LEGAL GUARDIAN:
Print Name: Signature:
Print Name:
Address: Address:
WITNESS: Date:
142021 PURE Insurance Championship Impacting The First Tee
September 21-26, 2021
Pebble Beach Golf Links and Poppy Hills Golf Course
Release of Liability and Acknowledgement of Risk
In consideration of my child being permitted to participate in activities associated with the PURE Insurance Championship Impacting
The First Tee (the “Event”), I, the undersigned parent/guardian, in full recognition and appreciation of the dangers and hazards
inherent in participating in the Event, does hereby agree to assume all risks and responsibilities surrounding and pertaining to my
child’s participation in the Event and associated activities; and
Further, I do for myself, my child, and my personal representative(s), heirs and assigns, hereby agree to defend, hold harmless,
indemnify, release and forever discharge PGA TOUR First Tee Foundation, Inc. (“First Tee”), PGA TOUR, Inc. (“TOUR”), the title
sponsor of the Event (if any), the Event facility (the “Facility”), the host organization (if applicable), and each of their respective
officers, directors, agents, members, officials, employees and affiliates (collectively, “Indemnified Parties”) from and against any and
all claims, demands and actions, or causes of action, on account of damage to a personal property, personal injury or death which may
result from my child’s participation in said Event and associated activities (including without limitation transportation to or from the
Event), whether or not such injury or damage or death was caused by their acts of negligence; and
Further, I do for myself, my child, and my personal representative(s), heirs and assigns, acknowledge that COVID-19 is extremely
contagious and that despite the measures the Event has implemented to help mitigate the risk of transmission, the elimination of risk of
exposure and infection to COVID-19 is not currently possible. By participating in the Event, I do, for myself and my child, assume all
risk and danger arising out of attendance at and/or participation in the Event, including out of or related to COVID-19.
Also, I give permission for my dependent to participate in all activities sponsored by or associated with the Event and to travel in the
vehicles provided by the Event personnel.
I understand that all and any transportation provided in connection with the Event will provided by adults. I further understand that
such transportation is provided by one or more independent, third party contractor(s) and not by First Tee.
I hereby release First Tee from liability for my dependent during travel to and from activities sponsored by the Event.
In witness whereof, I have caused this assumption of risk and release to be executed today.
________________________________ _____________________________ _______________
Parent/Guardian Signature Parent/Guardian Printed Name Date
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